子宫内膜透明细胞癌预后的相关因素及国际妇产科联盟2023版分期对其影响  

Prognostic characteristics of endometrial clear cell carcinoma and evaluation of the influence of Federation International of Gynecology and Obstetrics 2023 staging system on prognosis

作　　者：丁雪松 向阳[1] 杨隽钧[1] 曹冬焱[1] 万希润[1] 吴鸣[1] 潘凌亚[1] 李源[1] 张俊吉[1] Ding Xuesong;Xiang Yang;Yang Junjun;Cao Dongyan;Wan Xirun;Wu Ming;Pan Lingya;Li Yuan;Zhang Junji(National Clinical Research Center for Obstetric&Gynecologic Diseases,Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]国家妇产疾病临床医学研究中心、中国医学科学院北京协和医学院、北京协和医院妇产科,北京100730

出　　处：《中华医学杂志》2025年第8期592-597,共6页National Medical Journal of China

基　　金：国家重点研发计划(2023YFC2413400);首都卫生发展科研专项(首发2022-1-4011)。

摘　　要：目的分析子宫内膜透明细胞癌(ECCC)疾病特征与预后相关因素,探究国际妇产科联盟(FIGO)2023版分期风险分层对ECCC患者预后评估价值。方法回顾性纳入2012年3月至2023年12月在北京协和医院接受手术治疗的ECCC患者的临床资料,ECCC早期及晚期分别定义为Ⅰ~Ⅱ期及Ⅲ~Ⅳ期。通过Cox比例风险回归模型分析患者ECCC复发及死亡的相关因素[年龄、体质指数(BMI)、合并症、手术彻底性、病理类型、淋巴血管间隙浸润(LVSI)、子宫深肌层浸润(DMI)、宫旁浸润、淋巴结转移、期别、放化疗],结合FIGO 2023版分期评估预后差异。结果纳入125例ECCC患者,年龄为(60.4±11.0)岁,早期患者76例(60.8%),晚期49例(39.2%)。早期及晚期患者年龄、BMI、合并症比例、病理类型、接受化疗比例差异均无统计学意义(均P>0.05)。晚期患者存在LVSI[53.1%(26/49)比9.2%(7/76)]、DMI[69.4%(34/49)比23.7%(18/76)]、接受联合辅助疗法比例[51.0%(25/49)比25.0%(19/76)]均高于早期患者(均P<0.01)。随访时间[M(Q1,Q3)]为[66.1(38.3,101.5)]个月,多因素Cox比例风险回归模型分析显示高龄(HR=1.05,95%CI:1.01~1.09,P=0.008)、不满意肿瘤细胞减灭术(HR=5.81,95%CI:1.55~21.82,P=0.009)及肿瘤晚期(HR=1.43,95%CI:1.29~12.97,P=0.017)为ECCC患者肿瘤复发的相关因素;高龄(HR=1.07,95%CI:1.03~1.13,P=0.002)、不满意肿瘤细胞减灭术(HR=18.07,95%CI:3.15~103.61,P=0.001)为患者死亡相关因素。按照FIGO 2023版分期标准,Ⅰ~Ⅳ期患者5年无进展生存率分别为100.0%、90.2%、53.6%和25.5%,5年总生存率分别为100.0%、92.0%、64.4%和52.7%(均P<0.001)。结论ECCC确诊时晚期患者占比高,接受不满意的肿瘤细胞减灭术及疾病晚期为ECCC复发相关因素。FIGO 2023版分期有助于评估ECCC患者生存预后。Objective To investigate the clinicopathological features and prognostic characteristics of endometrial clear cell carcinoma(ECCC),and evaluate the 2023 Federation International of Gynecology and Obstetrics(FIGO)staging system on prognosis of ECCC.Methods The information of patients with ECCC who underwent primary surgery in Peking Union Medical College Hospital from March 2012 to December 2023 was collected.ECCC early and advanced stages were defined as StageⅠ-Ⅱand StageⅢ-Ⅳ,respectively.Cox proportional hazard regression was applied to evaluate the prognosis of patients with potential risk factors[age,body mass index(BMI),comorbidities,surgical completeness,histology,lymph vascular space invasion(LVSI),deep myometrial invasion(DMI),parametrial involvement,lymphatic metastasis,stage,adjuvant therapies including chemotherapy and radiotherapy],in combined with the 2023 FIGO staging system.Results A total of 125 patients with ECCC were included,with mean age of(60.4±11.0)years,76 cases of early stage patients(60.8%)and 49 cases of advanced stage patients(39.2%).The age,BMI,comorbidities,histology and receiving adjuvant chemotherapy were not statistically different between early and advanced stage patients(all P>0.05),while higher proportion of LVSI[53.1%(26/49)vs 9.2%(7/76)],DMI[69.4%(34/49)vs 23.7%(18/76)]and receiving adjuvant chemoradiotherapy[51.0%(25/49)vs 25.0%(19/76)]was observed in advanced stage(all P<0.01).With a median follow-up time[M(Q 1,Q 3)]of[66.1(38.3,101.5)]months,multivariate Cox proportional hazard regression model analysis showed that advanced age(HR=1.05,95%CI:1.01-1.09,P=0.008),suboptimal cytoreductive surgery(HR=5.81,95%CI:1.55-21.82,P=0.009),and advanced stage of tumor(HR=1.43,95%CI:1.29-12.97,P=0.017)were associated with tumor recurrence in ECCC patients;advanced age(HR=1.07,95%CI:1.03-1.13,P=0.002)and suboptimal cytoreductive surgery(HR=18.07,95%CI:3.15-103.61,P=0.001)were associated with patient death.According to the staging criteria of FIGO 2023,the 5-year progression free surv

关 键 词：子宫内膜肿瘤 预后 透明细胞癌 国际妇产科联盟分期 

分 类 号：R737.33[医药卫生—肿瘤]